Western Pacific Tang Soo Do: Dan Promotion Application

WESTERN PACIFIC TANG SOO DO

Application for Dan Promotion

All Cho Dan Bo and Dan members who wish to participate in an upcoming Dan Promotional Test must complete this application and receive approval prior to participation.

All Applications must be submitted a minimum of 3 months prior to the test date to be properly evaluated and approved for inclusion.

Dan Promotional candidate may also have to sign additional releases or waivers prior to testing.

Minimum Time in Grade Requirements

All candidates must meet the following minimum time in grade training and/or teaching hours requirements prior to applying for or being nominated for testing.

Cho Dan Bo -> Cho Dan: 1 year (100 hours min)

Cho Dan -> Ee Dan: 2 years (200 hours min)

Ee Dan -> Sum Dan: 3 years (300 hours min)

Sum Dan -> Sa Dan: 4 years (400 hours min)

Hours must be actual and not anecdotal. Training/Teaching records should be maintained for verifiable actual hours.

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INFO:

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Registrant Fee:		$0.00
Group Fee:		$0.00
Registration Fee:
Quantity Discount:		-
Promotional Discount:		-
Subtotal:
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Billing information

First Name

Last Name

Country

Address

City

State/Province

Zip/Postal

Phone

Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*EXCEEDMARTIALARTS 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
Please enter your full name in the space below.

Please click the button below to finalize your registration.

Registration inquiries:
Master Brooks Matsuda
6630 Flamingo Way
Sacramento, CA 95828

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Registrant

PERSONAL INFORMATION

First Name

Last Name

Address

City

State

Zip

Phone

Age

Birthdate

Uniform Size

Belt Size

Your Dan ID # (if applicable)

Dojang

Instructor

Recommended to test by:

Their Rank

Test Location (city, st)

Your Current Rank

Rank testing for

Date of last promotion

Promoted by

Organization

Your Time in Grade

Breaks in Training since last promotion (3 months or longer)

Do you have any breaks in training of 3 months or more?

Breaks in Training

If Yes, explain for how long & reason

Total Training hours since date of last promotion.

(Training hours: over 50% of your class attendance is training)

Enter Total Training Hours

Total Teaching hours since date of last promotion.

Enter Total Teaching Hours

PERSONAL TANG SOO DO BIO

Please tell us about your Tang Soo Do training

For example:

When you began
Original Instructor
Current Instructor
Dojang(s)
How long you've been training
etc.

Please also provide a passport size photo

Your Tang Soo Do Biography

TSD Biography

HEALTH & FITNESS

Do you have any health issues or physical limitations which may hamper or exclude you from fully participating in the Dan Promotional Test?

Do you have any Health or Fitness Issues?

Health or Fitness Issues?

Health/Fitness Issues

If Yes, Explain

WPTSD TESTING FEE

This is a Western Pacific Tang Soo Do ONLY fee for certification by the WPTSD.

This fee does not include any and all other fees or costs which my be applied by your instructor, dojang, or affiliated organization for participating in the Dan Promotional Test.

You have the option of making payment here on-line or in-person on or before the day of the event.

WPTSD TEST FEES

WPTSD Testing Fee:

Terms

I, the above named candidate, agree to all of these Terms & Conditions as set forth below in order to participate in the upcoming Dan Promotional Test.

I agree that my participation in this event is completely voluntary. No claims against Western Pacific Tang Soo Do, its affiliates, Instructors, and facility shall be made for any and all injuries I may sustain while participating in this event.

I agree that the above information is correct and true and that if any pertinent information is determined to be false or this application is incomplete, I may be excluded from participation or promotion.

If candidate is under 18, please enter the parent or legal guardian's name below who is accepting these terms on your behalf.

Check this box to indicate that you have read and agree to all of the above terms & conditions

I am 18 years old or older

Parent or Guardian's Name if under 18

I am

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